Coronary CT Angiography in ER Ups Decision-Making Efficiency

Last Updated: July 25, 2012.
Incorporating coronary computed tomographic angiography into evaluation of patients presenting to the emergency department with acute coronary syndrome symptoms improves the efficacy of clinical decision making, according to a study published in the July 26 issue of the New England Journal of Medicine.

WEDNESDAY, July 25 (HealthDay News) -- Incorporating coronary computed tomographic angiography (CCTA) into evaluation of patients presenting to the emergency department with acute coronary syndrome symptoms improves the efficacy of clinical decision making, according to a study published in the July 26 issue of the New England Journal of Medicine.

Udo Hoffmann, M.D., M.P.H., from the Massachusetts General Hospital in Boston, and colleagues conducted a multicenter trial in which patients aged 40 to 74 years with symptoms of acute coronary syndromes, without ischemic electrocardiographic changes or an initial positive troponin test, were randomized to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours.

The researchers found that, compared with standard evaluation, after early CCTA the mean length of stay in the hospital was reduced significantly, by 7.6 hours, and significantly more patients were discharged directly from the emergency department (47 versus 12 percent). There were no significant differences in major adverse cardiovascular events at 28 days between the groups and there were no undetected acute coronary syndromes. More downstream testing and higher radiation exposure was noted after CCTA. The cumulative mean cost of care was similar between the two groups ($4,289 for CCTA and $4,060 for standard evaluation; P = 0.65).

"In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care," the authors conclude.

Several of the authors disclosed financial ties to the pharmaceutical industry.